1. Blood transfusion พญ . เพชรรัตน์ วิสุทธิเมธีกร พ . บ ., ป . ชั้นสูงสาขาวิสัญญีวิทยา , วว . ( วิสัญญี ) ภาควิชาวิสัญญีวิทยา วิทยาลัยแพทยศาสตร์กรุงเทพมหานคร และวชิรพยาบาล

5. Blood blank practices # Antibody screen : Indirect Coombs test (45 mins) the subject serum + red cells ( antigenic composition) ----- red cell agglutination # Type&screen # Emergency transfusion

8. Blood blank practices All units – RBC @ PRC 1unit (250 ml Hct.70%) --platelet@ 1 unit (50-70 ml, stored at 20-24c for 5 days) --plasma @ FFP --cryoprecipitate @ high conc. Of factor VII, fibrinogen

10. Practice guideline $$ case series : reports of Jehovah witness; some may tolerate very low Hb< 6-8 g/dl in the perioperative period without an incresae in mortality

11. Practice guideline $$ In healthy, normovolemic individual, tissue oxygenation is maintained and anemia tolerated at Hct as low as 18-25%(Hb 6-8gm%) $$ RBC transfusion is rarely indicated when Hb> 10 g/dl and is almost always indicated when Hb< 6 g/dl American Society Anesthesiologist : 1996

12. คุณหมอขาหนูหน้าซีดแล้วต้องให้เลือดหนูหรือเปล่าคะ

14. Intraoperative transfusion practices 3. PLATELETS **thrombocytopenia or dysfunction platelets in the presence bleeding * prophylactic : plt.counts below 10,000-20,000 * prophylactic preoperative : plt.counts below 50,000 *Microvascular bleeding in surgical patient with platelets < 50,000 *Neuro/ ocular surgery > 75,000

16. Intraoperative transfusion practices 3. PLATELETS 50 ml: 0.5- 0.6 x 10 9 platelets (some RBC’s and WBC’s) Single donor apheresis OR Random donor (x 6)

20. “ Blood is still the best possible thing to have in our veins” - Woody Allen Blood transfusion is a lot like marriage. It should not be entered upon lightly, unadvisedly or wantonly, or more often than is absolutely necessary” - Beal

21. คุณหมอขาตัวหนูแดงทั้งตัวแล้ว แล้วคุณหมอเป็นไงบ้าง หัวบวมหรือยังคะ

24. Acute Hemolytic Transfusion Reaction Ab ( in recipient serum ) + Ag ( on RBC donor ) - Neuroendocrine responses -Complement Activation -Coagulation Activation - Cytokines Effects Acute hemolytic transfusion reaction Pathophysiology